World Journal of Gastrointestinal Endoscopy最新文献

{"title":"Sedation in endoscopy: Finding the balance between safety and efficacy.","authors":"Iyad A Issa, Remi Lakis, Taly Issa","doi":"10.4253/wjge.v17.i8.109695","DOIUrl":"10.4253/wjge.v17.i8.109695","url":null,"abstract":"<p><p>Sedation is the standard of care in gastrointestinal (GI) endoscopy in most institutions. Various protocols are employed to ensure a comfor patient experience and a high procedural success rate. Benzodiazepines combined with opioids are the most commonly used methods. However, these drugs have been associated with numerous adverse effects, including respiratory depression, hypoxia, and hypotension. Cohen <i>et al</i> conducted a study in this issue demonstrating the ability to minimize or eliminate opioid use without compromising procedural success rate or patient comfort. In this editorial, we explore the diverse sedation methods employed in GI procedures, assess the efficacy and safety of the drugs used, and highlight best practices.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"109695"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of high sessile serrated lesion detection: Role of faecal occult blood test and colonoscopy quality indicators.","authors":"Harry Williams, Natalie R Dierick, Christina Lee, Praka Sundaralingam, Stuart N Kostalas","doi":"10.4253/wjge.v17.i8.109176","DOIUrl":"10.4253/wjge.v17.i8.109176","url":null,"abstract":"<p><strong>Background: </strong>Sessile serrated lesions (SSLs) are premalignant polyps implicated in up to 30% of colorectal cancers. Australia reports high SSL detection rates (SSL-DRs), yet with marked variability (3.1%-24%). This substantial variation raises concerns about missed lesions and post-colonoscopy colorectal cancer. This study investigates determinants associated with SSL-DR variation in regional Australia.</p><p><strong>Aim: </strong>To study how patient, clinical, and colonoscopy factors are associated with SSL detection in a regional Australian practice. We aimed to contribute high-detection data to the literature by analyzing the association of SSL detection with various determinants.</p><p><strong>Methods: </strong>This retrospective, cross-sectional analysis examined 1450 colonoscopies performed at Port Macquarie Gastroenterology during 2023. Sigmoidoscopies and repeat procedures were excluded. Multivariate logistic regression analyzed associations between SSL detection and patient demographics, clinical indications, procedural factors, and comorbidities.</p><p><strong>Results: </strong>The overall SSL-DR was 30.7%. Multivariate analysis identified several independent predictors: Clinical indication, bowel preparation quality, inflammatory bowel disease status, and serrated polyposis syndrome. The faecal occult blood test positive (FOBT) (+) cohort showed the highest predicted SSL detection probability (39.8%), while clinical symptoms showed the lowest (22.3%). After adjustment, SSL detection odds were 2.3 times greater among FOBT (+) patients than those with clinical symptoms (adjusted odds ratio = 2.30, 95% confidence interval: 1.20-4.40, <i>P</i> = 0.004).</p><p><strong>Conclusion: </strong>SSL-DR as a quality indicator requires contextualization regarding clinical indications, bowel preparation quality, and comorbidities. There was a significantly higher prevalence of SSLs in FOBT (+) patients. Despite comprehensive adjustment, this study cannot fully explain the wide SSL-DR variation in Australia, highlighting the need for standardized detection protocols and further research to ensure optimal cancer prevention outcomes.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"109176"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoendoscopic surgery in gastrointestinal diseases: Status and future perspectives.","authors":"Kush Satyen Parikh, Payal Kaw, Ashok Kumar","doi":"10.4253/wjge.v17.i8.107617","DOIUrl":"10.4253/wjge.v17.i8.107617","url":null,"abstract":"<p><p>Laparoscopic and endoscopic cooperative surgery (LECS) is a hybrid minimally invasive technique originally developed for treatment of gastric submucosal tumors. Several modifications of LECS-including inverted LECS, non-exposed endoscopic wall-inversion surgery, and closed LECS have evolved over a period of time to address the earlier concerns about peritoneal contamination and tumor seeding. These innovations have led to the application of combined laparoendoscopic techniques to several gastrointestinal (GI) lesions such as the duodenum, colon, and rectum. This minireview explores the evolution, current applications, and future potential of laparoendoscopic surgery in GI diseases.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"107617"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic yield of video capsule endoscopy <i>vs</i> simple balloon enteroscopy in small intestinal disorders: A systematic review.","authors":"Eyad Gadour, Bogdan Miutescu, Hussein Hassan Okasha, Ana Maria Ghiuchici, Mohammed S AlQahtani","doi":"10.4253/wjge.v17.i7.108264","DOIUrl":"10.4253/wjge.v17.i7.108264","url":null,"abstract":"<p><strong>Background: </strong>Small-bowel disorders, including obscure gastrointestinal bleeding (OGIB), Crohn's disease, and tumors, require accurate diagnostic approaches for effective treatment. Video capsule endoscopy (VCE) and simple balloon enteroscopy (SBE) are widely used; however, each modality has limitations, particularly regarding therapeutic intervention and diagnostic yield.</p><p><strong>Aim: </strong>To evaluate diagnostic yields of various modalities for small bowel bleeding, analyze factors affecting heterogeneity, and improve understanding of clinical outcomes associated with different diagnostic approaches.</p><p><strong>Methods: </strong>A comprehensive search of four databases (PubMed, Embase, Cochrane Library, and Scopus) revealed over 600 citations related to the use of capsule endoscopy and balloon enteroscopy for diagnosing small intestine disorders with wall thickening. Based on predetermined eligibility criteria, seven moderate-to-high-quality retrospective studies were analyzed to evaluate the diagnostic performance of VCE and SBE in patients with small bowel disorders. Quality Assessment of Diagnostic Accuracy Studies was applied to evaluate the risk of bias and overall methodological quality.</p><p><strong>Results: </strong>Analysis of seven moderate-to-high-quality retrospective studies revealed comparable overall detection rates for small bowel lesions between VCE and SBE. VCE demonstrated superior performance in detecting vascular lesions. Conversely, SBE exhibited a higher efficacy in detecting ulcerative lesions. The overall diagnostic yield varied across studies, with VCE showing a range of 32%-83% for small bowel bleeding, whereas SBE demonstrated a higher overall detection rate of 69.7% compared to 57.6% for VCE (<i>P</i> < 0.05). Notably, SBE showed superior performance in diagnosing Crohn's disease, with a detection rate of 35%, compared to 11.3% for VCE (<i>P</i> < 0.001). The diagnostic concordance between VCE and SBE was influenced by the lesion type. Strong agreement was observed for inflammatory lesions (κ = 0.82, 95%CI: 0.75-0.89), whereas moderate agreement was noted for tumors (κ = 0.61, 95%CI: 0.52-0.70) and angiectasias (κ = 0.58, 95%CI: 0.49-0.67). SBE demonstrated significant advantages in therapeutic interventions, particularly in overt bleeding. Patient tolerability was generally higher for VCE, with a completion rate of 95% (95%CI: 92%-98%), compared to 85% for SBE (95%CI: 80%-90%). However, the capsule retention rate for VCE was 1.4% (95%CI: 0.8%-2.0%), necessitating subsequent intervention.</p><p><strong>Conclusion: </strong>VCE and SBE are complementary techniques for evaluating small intestinal disorders. Although VCE remains the initial test of choice for patients with stable OGIB, SBE should be considered in patients requiring therapeutic intervention. Thus, combining both modalities enhances diagnostic accuracy and patient management.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 7","pages":"108264"},"PeriodicalIF":1.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic management of biliary leaks: Where are we now?","authors":"Alberto Tringali, Deborah Costa, Daryl Ramai","doi":"10.4253/wjge.v17.i7.107587","DOIUrl":"10.4253/wjge.v17.i7.107587","url":null,"abstract":"<p><p>Biliary leaks can arise as a consequence of cholecystectomy, liver surgery, liver transplant, or, less frequently, trauma. Early identification and characterization of these leaks are crucial, as they can significantly enhance patient outcomes by reducing morbidity and mortality. Traditionally, surgical repair has been the standard treatment; however, advancements in endoscopic techniques and tools have established endoscopic retrograde cholangiopancreatography (ERCP) as the primary approach for managing these often-complicated cases. Interventions such as sphincterotomy, nasobiliary drainage, and stent placement aim to alleviate the pressure within the bile duct, facilitating depressurization and promoting leak healing. Alongside ERCP, endoscopic ultrasound is playing an increasingly vital role in addressing challenging cases. Ongoing improvements in endoscopic technologies and methodologies offer promising prospects, often minimizing the need for invasive surgical interventions. Nonetheless, the management of biliary leaks continues to pose significant challenges for clinicians. An optimal approach for patients experiencing bile leakage should be determined on a case-by-case basis and discussed within a multidisciplinary team involving radiologists, endoscopists, and surgeons. This comprehensive review aims to elucidate the role of endoscopy in the management of various types of biliary leaks, providing clinicians with practical insights to navigate this complex field.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 7","pages":"107587"},"PeriodicalIF":1.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal air embolism during intestinal endoscopy in Kasai portoenterostomy for biliary atresia: A case report.","authors":"So Young Shin, Hee Jin Yeon, Sang On Lee, Jeong Rim Lee, Galam Leem, Seok Joo Han","doi":"10.4253/wjge.v17.i7.105773","DOIUrl":"10.4253/wjge.v17.i7.105773","url":null,"abstract":"<p><strong>Background: </strong>Air embolism (AE) is a rare but potentially fatal complication of intestinal endoscopy (IE).</p><p><strong>Case summary: </strong>Herein, we report the case of an 18-year-old woman who underwent a successful Kasai portoenterostomy (KPE) for biliary atresia but died of AE during intraoperative IE for stone removal at the portoenterostomy site. Our review of the English literature identified only four similar cases of fatal AE during IE in patients undergoing KPE. The common clinical setting in the five patients, including our case, was high-pressure air insufflation into the blind closed afferent loop of the KPE to secure visibility. We hypothesize that the highly pressurized air injected into the closed loop entered the bile canaliculi-previously opened by KPE for bile drainage-passed through the tiny, microscopic pores of the fenestrated liver sinusoid endothelial cells, and finally entered the bloodstream with ease, resulting in fatal AE.</p><p><strong>Conclusion: </strong>Meticulous performance of IE, especially on the KPE blind loop, is warranted owing to the risk of AE.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 7","pages":"105773"},"PeriodicalIF":1.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative schemes of colonoscopy bowel preparation with oral lactulose: Optimizing traditional standards to improve colonoscopy quality.","authors":"Josué Aliaga Ramos, Danilo Carvalho, Vitor Nunes Arantes","doi":"10.4253/wjge.v17.i7.107168","DOIUrl":"10.4253/wjge.v17.i7.107168","url":null,"abstract":"<p><p>The bowel preparation is a crucial step to achieve an optimal quality in colonoscopy. The major clinical impact of an adequate colonic cleansing is to allow a more detailed and thorough inspection reducing the rates of missing lesions during the procedure and consequently reducing the incidence of interval colorectal carcinomas. Currently there are different colonoscopic preparation schemes, being the polyethylene glycol (PEG) based regimen one of the most used and recommended by the main international clinical guidelines. Nevertheless, PEG preparation requires the ingestion of considerably large volumes to achieve an optimal colonic cleansing, leading to poor tolerability in may patients, particularly in an elderly population. Other aspects that make accessibility to most colonoscopy preparation regimens difficult is their high cost and low availability. New options of colonoscopic preparation schemes based on oral lactulose are emerging with promising results, showing excellent efficacy-safety profiles and high tolerability indexes. Lactulose regimens present other benefits such as low cost and wide availability. The aim of this review is to analyze the scientific evidence to date and the current status of colonoscopy bowel preparation utilizing lactulose-based regimens, in order to consolidate this agent as a feasible \"new player\" in the field of colonoscopic preparation.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 7","pages":"107168"},"PeriodicalIF":1.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-endoscopic retrograde cholangiopancreatography cholecystitis: A review of incidence, risk factors, prevention, and management.","authors":"Suprabhat Giri, Shivaraj Afzalpurkar, Prasanna Gore, Gaurav Khatana, Saroj Kanta Sahu, Dibya Lochan Praharaj, Bipadabhanjan Mallick, Preetam Nath, Sridhar Sundaram, Manoj Kumar Sahu","doi":"10.4253/wjge.v17.i7.108030","DOIUrl":"10.4253/wjge.v17.i7.108030","url":null,"abstract":"<p><p>Post-endoscopic retrograde cholangiopancreatography (ERCP) cholecystitis (PEC) is a recognized adverse event associated with ERCP. The incidence of PEC is low in patients undergoing ERCP, but is high in specific subgroups, such as those receiving fully-covered self-expandable metallic stents (SEMS). Several risk factors contribute to PEC, including gallbladder (GB)-related factors like tumor involvement of the orifice of the cystic duct (OCD) or feeding artery, and associated gallstones. Stent-related factors, such as covered stent placement and high axial force stents, and procedure-related factors, including stent placement across the OCD and contrast injection into the GB, further elevate the risk. Prevention strategies focus on modifying techniques, such as careful contrast administration and stent selection (uncovered or low axial force SEMS), and considering prophylactic GB drainage through endoscopic transpapillary GB drainage (ETGBD) or endoscopic ultrasound-guided GB drainage (EUS-GBD), especially in high-risk patients. Treatment options for PEC range from conservative management with antibiotics to more invasive interventions like percutaneous transhepatic GB aspiration or drainage, endoscopic techniques (ETGBD, EUS-GBD), and cholecystectomy. The choice of treatment depends on the severity of cholecystitis, the patient's condition, and other factors. The present review summarizes the currently available literature on the incidence, predictors, prevention, and management of PEC.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 7","pages":"108030"},"PeriodicalIF":1.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revolutionizing upper gastrointestinal disease diagnosis: The transformative role of artificial intelligence in endoscopy.","authors":"Xin-Rui Li, Mo-Wei Kong, Xiang-Feng Guan, Yu Gao","doi":"10.4253/wjge.v17.i7.108293","DOIUrl":"10.4253/wjge.v17.i7.108293","url":null,"abstract":"<p><p>With the rapid advancement of technology, artificial intelligence (AI) has emerged as a transformative force in gastroenterology, particularly in diagnosing upper gastrointestinal diseases such as Barrett's esophagus (BE), esophageal cancer, gastroesophageal reflux disease (GERD), and esophagogastric varices. AI's capabilities in image analysis, classification, detection, and segmentation have significantly improved diagnostic accuracy and efficiency. For BE, AI models achieve high sensitivity and specificity in detecting early neoplastic changes and guiding targeted biopsies. In esophageal cancer, AI enhances early lesion detection, improving intervention success rates. For GERD, AI classifies disease severity based on the Los Angeles grading system and accurately segments lesions. Additionally, AI detects esophagogastric varices and predicts bleeding risks more effectively than traditional methods. Despite these advancements, challenges remain, including the need for high-quality data, multi-center validation, and ensuring AI model interpretability. Future research should address these issues and further integrate AI into clinical practice to optimize patient outcomes. This review highlights AI's transformative impact on upper gastrointestinal disease diagnosis, emphasizing its potential to revolutionize endoscopic practice and improve patient care.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 7","pages":"108293"},"PeriodicalIF":1.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant functional gallbladder disorder and left-sided gallbladder: A case report.","authors":"Jing-Rui Wu, Chang-Cheng Wang, Bo-Yang Li, Jia-Hang Li, Tao Zhang, Zi-Yao Li","doi":"10.4253/wjge.v17.i7.107059","DOIUrl":"10.4253/wjge.v17.i7.107059","url":null,"abstract":"<p><strong>Background: </strong>Ectopic gallbladder, occurring in 0.1% to 0.7% of the population, is rarely found in the left liver lobe without situs inversus totalis. Functional gallbladder disorder (FGBD), characterized by biliary pain without stones or sludge, affects 8% of men and 21% of women. No prior cases of concomitant FGBD and left-sided gallbladder have been reported, posing diagnostic and surgical challenges.</p><p><strong>Case summary: </strong>A 73-year-old woman with a 20-year history of epigastric pain was diagnosed with a left-sided gallbladder and FGBD based on imaging findings and impaired gallbladder contraction. Laparoscopic cholecystectomy was performed and confirmed the ectopic gallbladder adherent to the left liver lobe. Postoperative pathology revealed no abnormalities, and the patient achieved complete symptom resolution at three-month follow-up.</p><p><strong>Conclusion: </strong>This is the first reported case of FGBD with a left-sided gallbladder. Preoperative imaging, such as magnetic resonance cholangiopancreatography or computed tomography, is crucial for identifying anatomical variations of the gallbladder. Laparoscopic cholecystectomy is feasible but requires careful planning to avoid complications.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 7","pages":"107059"},"PeriodicalIF":1.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}